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Redo transanal endorectal pull-through: a preliminary study
T A Gobran1, A Ezzat, M E Hassan
1General surgery department, Pediatric surgery Unit, Faculty of medicine, Zagazig University, Zagazig City, 44511, Egypt.
Insights
Redo transanal endorectal pull-through (TEPT) effectively treats persistent symptoms in children with Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung's disease (HD) can lead to persistent obstructive symptoms post-surgery.
- Revision surgery is sometimes necessary for refractory cases.
Purpose of the Study:
- To evaluate the safety and efficacy of redo transanal endorectal pull-through (TEPT) for children with persistent symptoms after initial pull-through for HD.
Main Methods:
- Retrospective review of seven pediatric patients (2.5-6 years) undergoing redo TEPT.
- Indications included persistent constipation, anastomotic stricture, and enterocolitis.
- Follow-up averaged 12 months, assessing symptom relief and complications.
Main Results:
- All patients achieved relief from obstructive symptoms and had no soiling post-redo TEPT.
- Two patients experienced mild enterocolitis, managed conservatively.
- No deaths, anastomotic leakage, or persistent strictures were reported. EMG showed good sphincter function.
Conclusions:
- Redo TEPT is a safe and effective alternative for managing persistent symptoms in Hirschsprung's disease patients.
- The procedure demonstrates good functional outcomes and a favorable safety profile.
Abstract:
The aim of this study is to evaluate the safety and efficacy of the redo transanal endorectal pull-through (TEPT) for patients with persistent symptoms after pull-through for Hirschsprung's disease (HD). Seven children were included in the study, their ages ranged from 2.5 to 6 years (four males and three females). They presented with persistent obstructive symptoms after pull-through for HD, which was remediated with redo TEPT. Indications were persistent constipation, anastomotic stricture unresponsive to dilatation with or without attacks of enterocolitis. Mean follow-up period was 12 months (ranged from 8 to 16 months). Obstructive symptoms were relieved in all patients with no soiling throughout the period of follow-up. Enterocolitis developed once in two patients who responded to conservative management after hospitalization. There were no deaths and anastomotic leakage, persistent stricture and cuff abscess did not develop in our series. EMG mapping of the external anal sphincter showed a good resting and powerful squeezing pressure curve. Redo TEPT is a useful alternative procedure for persistent symptoms of HD, and it appears to be safe and effective.
